Mortality according to glucose tolerance was studied to determine the prognosis of impaired glucose tolerance. In 1962-65, 228,833 subjects were screened for glycosuria. Of 2477 with glycosuria, 2180 were given oral glucose tolerance tests, and grouped according to normal tolerance, impaired glucose tolerance, or diabetes by World Health Organization criteria. Among subjects at least 25 years old with normal tolerance, impaired glucose tolerance, or diabetes, age-sex-adjusted mortality through 1983 was, respectively, 39+2, 49+4, and 71+4 deaths/1000 person-years(+ standard error) for all causes (p<. 001 f or difference in 3 groups) , and 24+2, 25+3, land 40+3, respectively, for vascular causes (cardiovascular, cerebrovascular, or renal disease) (p<.001). 206 men with abnormal tolerance by local, but not World Health Organization, criteria were randomly assigned to diet with tolbutamide, diet only, or no treatment, which was continued through 1975. Age-adjusted all-cause mortality through 1983 did not differ significantly among treatment groups (34+9, 52+10, 45+19), but vascular mortality was 10+5, 31+8, and 38+19, respectively, in those assigned to tolbutamide, diet only, or no treatment (p<.05). Thus compared with persons with normal tolerance, diabetic subjects had higher all-cause and vascular mortality, and those with impaired glucose tolerance had higher all-cause but similar vascular mortality. Treatment of abnormal glucose tolerance apparently reduced vascular but not total mortality.